How can we improve functional outcomes?

Health has multiple dimensions. In a broad sense, health can be considered in terms of physical, mental and social well-being, but this may be difficult to measure, particularly in whole populations. The earliest population indices of health were based on readily available and unambiguous indicators, such as mortality; and these were applied to particular age groups, such as the first year of life (infant mortality). The legal requirement in many societies to record mortality meant that generally complete data could be obtained. However, although such information has been of considerable value, this may change over time as societies evolve. Health indicators are often specifically chosen to reflect current problems within societies, especially those requiring improvement. Mortality statistics may reveal new layers of concerns, which may lead to the development of new indicators of health outcome to reflect these new concerns. For example, in low income countries, where infant mortality is high (or mortality from specific treatable diseases are high) appropriate policies may produce improvements in outcome relatively easily. In developed countries, where this mortality has already been reduced to very low levels, the cost of reducing it to an even lower level may be disproportionately high and unacceptable to policy makers. Therefore, new policies are established so that resources can be redirected to address other more important health problems in the general population. For example, as survival from a particular condition or groups of conditions improves, a range of persisting disabilities may develop, e.g. increasing life expectancy in countries with well-developed economies is associated with greater disability and dependency in older life, and a poorer quality of life. As a consequence, indicators of these health outcomes have become increasingly more prominent in Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 233–247, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.